Thursday, September 27, 2012

Just Say No?
After a few months of very sporadic appointments, my case study client Mrs. R will be available again for weekly, 2 hour massages. I'm excited to make some progress, since the prolonged breaks in treatment have put us back in a routine of putting out fires, instead of making lasting holistic, structural improvements. Today's 2 hour session was just that- getting the neck moving again while trying to minimize inflammation caused by so much deep tissue work in that concentrated area. Then some back work focusing on loosening the tissues close to the spine.

Erik Dalton, PhD
When I started the case study, it was supposed to coincide with my home study course from Eric Dalton in Myoskeletal Alignment. I still haven't completed the quiz to become officially certified by the Freedom from Pain Institute, but I feel like I'm still learning plenty, albeit slowly. I've been reading sections of the text and trying to apply it to my clients in small doses, mixed with my tried and true techniques. With Mrs. R, because of her complex issues, I'm relying on the stuff I've used for close to a decade, not the specific techniques I've learned over the past few months. The Myoskeletal perspective, however, has been invaluable in helping me see through the complex strain patterns, to decipher where and how some of my old standby techniques should be implemented.

The question I have now, is how to approach the pharmaceutical element of Mrs. R's treatment. 
Gabapentin, Hydrocodone, and Meloxicam daily with over the counter migraine medicine when needed. That's what she has been taking for years now. One doctor tells her that she can't stop or lower the pain meds because the pain will come right back- essentially, she will be taking these powerful substances forever. A new doctor is creating a plan to ween her off the drugs because there is so much going on. The new plan should be explained to Mrs. R next week before I see her again. Aside from drugs, she says massage therapy has been the only thing to ever give her relief. While I am anxious to provide as much relief as soon as possible, because I know she is in a lot of pain despite the pharmaceutical pain killers, it's hard to condone doing deep tissue massage on someone who is so numb to sensory input. On the other hand, she couldn't handle the massage treatments as well without the medicine- it creates her baseline, it's a part of her now. We continue to have great communication during the massage and I'm confident enough in my work that I don't believe I'm doing any harm to her tissues. I feel similar tension everyday in other clients.

For example, Mrs. R drives, sits at a desk, and works at a computer, for long hours every day. The strain patterns produced by those prolonged postures clearly express themselves in her upper crossed syndrome, tight pec'd, tight scalene'd structure. All that stuff is on top of whatever disc issues are in there. I would know if I were poking my fingers into something that didn't belong, since I've worked on the necks of cubicle dwellers and long distance drivers for years now- thousands of them. I will continue to be very cautious with Mrs. R, and look forward to hearing a fresh perspective, but I sincerely believe my work thus far has been beneficial and not damaging.

There is also the somewhat pressing issue of motherhood. Mrs. R wants several children and can't take the pills while pregnant, so she needs a natural pain relieving therapy, at least while she's tending the cabbage patch, which may be 5-7 years. The goal is to find a way to provide therapy which will balance her soft tissue structures, to allow for optimum mobility and function, within her comfort level and with her doctor's blessing, that lasts a long time.

A few key background posts about the Mrs. R Case Study: Here, Here, and Here.

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